Provider Demographics
NPI:1609914399
Name:BOVIO, BRITT SHANK (DMD)
Entity Type:Individual
Prefix:
First Name:BRITT
Middle Name:SHANK
Last Name:BOVIO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 N MILLER ST
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2044
Mailing Address - Country:US
Mailing Address - Phone:509-662-3621
Mailing Address - Fax:
Practice Address - Street 1:650 N MILLER ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2044
Practice Address - Country:US
Practice Address - Phone:509-662-3621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17533122300000X
WADE60222963122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist